tbuckley/cabot-search huggingface dataset:
Abstract 13882: Myocardial Hypoperfusion in Severe Aortic Stenosis is Reversed by Aortic Valve Replacement
Authors: George D Thornton, Jonathan B Bennett, Christian Nitsche, Francisco Gama, Rok Mravljak, Aderonke T Abiodun, Nikoo Aziminia, Leire Tapia, Kristopher Knott, Iain Pierce, Guy Lloyd, Alun Hughes, Rhodri H Davies, Arantxa Gonzalez, James Moon, Peter Kellman, Thomas Treibel
Journal: Circulation (2023)

Background: Myocardial hypoperfusion in severe aortic stenosis (AS) without obstructive coronary disease may be secondary to hemodynamic influences (and therefore readily reversible by aortic valve replacement[AVR]) or structural alterations in the left ventricle (LV) such as increased mass and reduction in capillary density. Aim: To evaluate the early effect of AVR on myocardial blood flow (MBF) in patients with severe symptomatic AS without flow-limiting coronary artery disease. Methods: Prospective case-control study of severe symptomatic AS without obstructive coronary disease referred for surgical or transcatheter AVR and propensity matched to a control cohort with unobstructed coronary arteries. Patients underwent adenosine stress cardiovascular magnetic resonance at baseline and 8-weeks (median) post-operatively. Histology from 9 myocardial septal biopsies taken at AVR were compared against necropsy controls (n=5). Results: 52 patients were included; 26 with severe AS (median [IQR] age 71[66-75], 73% male) and 26 age, sex and co-morbidity matched controls. In AS, peak velocity(Vmax) was 4.3m/s[4.1-4.5] and AVA 0.8cm 2 [0.6-0.9]. AS patients had greater LV mass and late gadolinium enhancement. AS patients had lower stress MBF than controls (1.63ml/g/min[1.38-2.08] vs 2.13[1.76-2.52], p=0.003) which increased to 1.97ml/g/min after AVR (p=0.7 post-AVR vs. Controls). This was driven by a 40% increase in subendocardial MBF (1.26ml/g/min[1.18-1.78] to 1.77[1.62-2.32]). Capillary density was reduced almost threefold in AS (495/mm 2 [407-686] vs 1376[1208-1579], p&lt;0.001). Conclusions: Severe AS results in subendocardial hypoperfusion which is rapidly improved after AVR. There is a threefold reduction in capillary density, however factors related to elevated afterload (which is reduced by AVR) are the most influential.
Abstract 19134: Association Between CHA <sub>2</sub> DS <sub>2</sub> -VASc and LA Volume Index: Insights From DECAAF II
Authors: Ala' Y Assaf, Charbel Noujaim, Mario Mekhael, Nour Chouman, Ghaith Shamaileh, Omar Kreidieh, eoin donnellan, Amitabh C Pandey, Han Feng, Cecile McGarvey, Chanho Lim, Nassir Marrouche
Journal: Circulation (2023)

Introduction: LA Volume is strongly associated with atrial fibrillation (AF) and underlying atrial myopathy. The CHA 2 DS 2 -VASc score predicts stroke risk in patients with AF. The aim of this study is to investigate the relationship between the two. Methods: In this subanalysis of the DECAAF II trial, patients with persistent AF undergoing first-time catheter ablation underwent a baseline late gadolinium enhancement magnetic resonance imaging (LGE-MRI) within one month prior to ablation. LA Volume Index (LAVI) was defined as LA Volume on the MRI prior to ablation divided by body surface area ( mL/m2 ). The CHA2 DS2 -VASc score was also calculated at baseline prior to ablation. Analysis of Variance (ANOVA) test and linear regression were used to study the association between the two. Results: 815 patients were included, (78.9% males, mean age 62.7 ± 9.1 years) (table). The mean LAVI was 62.2 ± 18.9 mL/m2, and mean CHA2 DS2 -VASc score was 1.7 ± 1.27. The ANOVA test showed significant differences between group (F = 7.71, p &lt;0.001). For every point increase in CHA2 DS2 -VASc score, LAVI increases by 3 (LAVI = 2.99 * CHA2 DS2 -VASc + 57; p &lt;0.001) (figure). Conclusions: Our data suggests that structural remodeling in patients with AF is likely driven by multiple factors. There was a clear association between CHA2 DS2 -VASc score and higher LAVI. Serial analysis of LA Volume at different time points is needed to further understand the impact of individual comorbidities on LA volume dilation.
Abstract 13855: Epigenetic Aging Markers Mediate the Association of Life’s Essential Eight With Cardiovascular Disease and All-Cause Mortality
Authors: Madeleine Carbonneau, Yi Li, Chunyu Liu, Tianxiao Huan, Roby Joehanes, Joanne Murabito, Nancy Heard-Costa, Jiantao Ma, Daniel Levy
Journal: Circulation (2023)

Background: The American Heart Association recommended Life’s Essential 8 (LE8) as a simple cardiovascular health (CVH) metric. While optimal LE8 scores are associated with greater CVH and longevity, the mechanisms underlying these associations are unclear. Objective: To characterize the associations between LE8, epigenetic age scores, CVD, and all-cause mortality. Methods: LE8 scores were calculated for 5,669 participants in the Framingham Heart Study. Mixed proportional hazard models were used to evaluate the associations between LE8 score and CVD and all-cause mortality. We conducted mediation analyses to calculate the proportion of the association between LE8 score and CVD and all-cause mortality that is mediated by DNA methylation-based epigenetic age markers (GrimAge and PhenoAge). We performed stratified mediation analyses based on median-dichotomized polygenic risk score (PRS) of epigenetic age markers. Results: Higher LE8 scores, indicating better CVH, were associated with lower risk of CVD. One standard deviation (SD) increase in LE8 score was associated with a 35% decreased risk of CVD (95% CI: 27%, 41%, p =1.8E-15). One SD increase in LE8 was also associated with a 29% decreased risk of all-cause mortality (95% CI: 22%, 35%, p =7.0E-15). These associations were partly mediated by epigenetic age: the mean proportions of mediation by GrimAge and PhenoAge were 21% and 2% ( p =0.23) for CVD and 67% and 6% for all-cause mortality, respectively. In our stratified analysis, potential mediation effects of GrimAge and PhenoAge were more profound in participants with a higher PRS. For GrimAge, the proportion of mediation for the association between LE8 and CVD was 39% (95% CI: 14%, 80%, p =8.8E-04) for participants in the upper half of higher GrimAge PRS whereas there was no significant mediation for those with low GrimAge PRS values. For the association between LE8 and all-cause mortality, the proportion of mediation by GrimAge was 81% (95% CI: 48%, 100%, p &lt;2.0E-16) in participants with the highest GrimAge PRS and not significant for those with the lowest GrimAge PRS. Conclusion: LE8 shows a strong association with CVD and all-cause mortality. Our observations suggest that these associations are mediated in part by DNA methylation-related mechanisms.
Abstract 19176: Atrial Fibrillation Prevalence With Mavacamten for Obstructive Hypertrophic Cardiomyopathy
Authors: likhitesh jaikumar, Monodeep Biswas, Calvin Kagan, Richard S Amara, Kim M Reck, Stephen Shorofsky, Timm Dickfeld, Libin Wang, Vincent Y See
Journal: Circulation (2023)

Introduction: Mavacamten is a first-in-class, small molecule, selective cardiac myosin inhibitor for treatment of symptomatic obstructive hypertrophic cardiomyopathy (HCM). Partial reversal of hypertrophic remodelng, diastolic dysfunction, and sarcomeric calcium sensitivity have been reported. While atrial fibrillation (AF) prevalence is observed in ~10% of pre-approval study subjects, the effects of mavacamten on AF have not been reported. Hypothesis: AF prevalence remains elevated after mavacamten therapy for HCM Methods: Chart review was performed for standard of care clinical encounters, 12-lead ECG, and echocardiography (TTE) for patients treated mavacamten at a single HCM referral center. Results: Among 12 patients prescribed mavacamten, 92% had no prior AF symptoms nor diagnosis. After 6 months of mavacamten therapy, 25% had AF with 17% new-onset. TTE demonstrated resolution of LVOT gradients in 100% of AF patients at 6 months. Case 1: 60-year-old male with OSA and LVOT gradients of 31 mmHg at rest and 41 mm Hg with Valsalva was started on mavacamten for exertional fatigue and dyspnea. After 3 months, he developed new-onset, paroxysmal AF treated by TEE-guided cardioversion, amiodarone and apixiban. Case 2: 66-year-old female with LVOT gradients of 38 mmHg at rest and 74 mm Hg with Valsalva initiated mavacamten for exertional dyspnea. After mavacamten initiation, exertional symptoms improved but frequent episodes of symptomatic AF persisted despite sotalol 120mg. Case 3: 58-year-old female with LVOT gradient of 97 mm Hg at rest and no change with Valsalva and dyspnea on exertion. After unexplained syncopal events, an implantable cardiac monitor recorded AF. After 1 month of mavacamten, she experienced increased frequency of AF. Conclusions: In a single center experience with mavacamten, AF prevalence of 25% with 17% new onset AF developed despite improvement in symptoms and hypertrophic remodeling parameters. As a novel cardiac myosin inhibitor that attenuates hypertrophic remodeling, diastolic dysfunction, and calcium sensitivity that are anticipated to reduce AF susceptibility, more observation of arrhythmia incidence and burden in larger cohorts will inform arrhythmia outcomes and mechanisms in HCM.
Abstract 13848: Time to Coronary Angiography in Patients With NSTE-ACS is Longer in Women as Compared to Men
Authors: Sukardi Suba, Mary G Carey, Michele M Pelter
Journal: Circulation (2023)

Introduction: Timely invasive coronary angiography (ICA) to restore myocardial blood flow in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) improves prognosis and reduces morbidity and mortality. NSTE-ACS practice guidelines recommend ICA &lt;2 hours [hrs] (very high-risk) or &lt;24 hrs (high-risk). Troponin is useful for guiding timing of ICA. However, there is little evidence comparing time to troponin and ICA in women vs. men, which could uncover important treatment differences. Therefore, the purpose of this study was to examine time to ICA and first troponin in women vs. men in a cohort of hospitalized NTSE-ACS patients. Methods: Secondary data analysis in 121 patients with NSTE-ACS; women ( n =41, 34%) vs. men ( n =80, 66%), who underwent ICA and had a troponin test. Variables of interest were obtained from the electronic health record. Results: Compared to men, women were older (67±12 vs. 62±11 years, p =0.039), had a higher proportion of diabetes (44% vs. 19%, p =0.006), and were non-smokers (61% vs. 31%, p =0.013). Time, in minutes , to first troponin did not differ between women vs. men (81.53±261.04 vs . 33.49±107.20, p =0.167), when including one outlier (one woman). Excluding this outlier, it remained non-significant (44.43±127.66 vs. 33.49±107.20, p =0.167). Overall, the time to ICA, in hours , was longer in women than men (24.01±27.64 vs. 13.83±12.89, p= 0.007). The first troponin was positive in 26 women (67%) and 53 men (69%), p =0.98; however, time to ICA, in hours , was longer in women vs. men (21.55±20.26 vs. 12.56±11.41, p= 0.014). Conclusions: In patients with confirmed NSTE-ACS, time from admission to ICA was nearly twice as long in women as compared to men. One explanation could be symptoms differences and should be explored further. Time from admission to first troponin was not statistically different (with and without oulier [one women]). Despite an equivalent rate of the first troponin being positive, time to ICA was on average 9 hours longer in women vs. men. Future studies in a larger cohort(s) using contemporary data are needed to explore possible reasons for ICA delay (symptoms and clinical characteristics) to confirm if similar trends persists and whether short- and long-term outcomes are different by sex.
Abstract 16094: Depressive Disorder and Quality of Life in Patients With Heart Failure
Authors: Massiel K Cañavera, Camilo A Hernandez, Juan F Carvajal, Miguel E Ochoa, Maria L Luna-Gonzalez, Mayra A Diaz
Journal: Circulation (2023)

Background According to the WHO 17.9 million people die every year owing to cardiovascular disease. Due to the increase in prevalence, heart failure (HF) is an important public health problem with more than 23 million people; its prevalence is expected to increase 46% by 2030. The presence of depression can affect up to 21.5% patients with HF, deteriorating quality of life with an increase in hospitalization and mortality rates. Aims Evaluate the factors associated with depressive symptoms and quality of life in patients with HF. Methods: Observational, analytical, transversal study with secondary analysis of 153 patients with HF treated in an outpatient clinic, considering baseline characteristics, echocardiogram parameters and depressive/quality of life PHQ-9 and Minnesota scales for univariate and bivariate analysis. Results: There was an association between the compromise of NYHA III-IV vs NYHA I-II functional class with: moderate to severe degree of depression (44,44% vs 24,9%) and impaired quality of life (61.11% vs 26.54%) p≤ 0.001, respectively. Likewise, statin use was associated with less depression (30.23% vs 11.82% p=0.006) and quality of life improvement (32,56% vs 14,55% p=0.012) respectively, this was independent of psychosocial support. Atrial fibrillation had a significant association with depression (p=0.030) and history of cerebrovascular disease (p=0.009). Conclusion: Depression is an important and common comorbidity that often coexist in patients with HF and are associated with poor quality of life. It is important to screen for depressive symptoms in these patients with the goal to provide appropriate treatment and avoid negative outcomes.
Abstract 13876: Women Face Unique Obstacles During Pediatric Cardiology Fellowship Training
Authors: Caroline L West, Sunkyung Yu, Ray Lowery, Caren S Goldberg, Sowmya Balasubramanian
Journal: Circulation (2023)

Background: There are persistent disparities in career advancement for women physicians in pediatric cardiology. We sought to explore differences by gender in fellowship experience, as these may set the foundation for long-term gender inequity. Aims: To describe and compare fellowship experiences, career aspirations and family obligations of men and women in pediatric cardiology training. Methods: We performed a national survey of pediatric cardiology fellows examining mentorship, scholarly and DEI work, clinical experiences, career intentions and family commitments. Descriptive analyses were performed. Results: A total of 176 responses were included in the analysis (men=74, women=102). Most fellows were white (69%) and aged 30-34 years old (68%). Men and women reported similar mentorship, scholarly and clinical experiences, and influential factors in their decision to pursue subspecialty training. More women plan to pursue advanced imaging training (42% vs. 24%, p=0.04), to have administrative responsibilities (27% vs. 14%, p=0.06), and to work part time during their career (28% vs. 5.6%, p=0.001). Men reported greater interest in teaching (93% vs. 83%, p=0.04). While similar proportions of men and women were married, the spouses of women were more likely to be employed (91% vs. 71%, p=0.002). Among fellows with children, more women than men planned for additional children (75% vs. 25%, p=0.0004). Among fellows without children, more men than women planned for additional children (93% vs. 74%, p=0.01). Women were more likely to report delay in childbearing due to training (71% vs. 40%, p=0.0002), that childbearing decisions were influenced by the risk of radiation exposure (22% vs. 0%, p&lt;.0001), and the use of assistive reproductive technologies (11% vs. 1%, p=0.01). Conclusion(s): Women and men in pediatric cardiology fellowship have similar training experiences and career aspirations yet differ in their plans to raise families. Women face unique obstacles to childbearing and child raising during training. Motherhood in pediatric cardiology may be a vulnerable period during career development and advancement.
Abstract 13820: Association of Cardiothoracic Ratio With Heart Failure Events in Atrial Fibrillation Without Heart Failure: The Fushimi AF Registry
Authors: Syuhei Ikeda, Yasuhiro Hamatani, Keita Okamoto, Yumiko Nakanishi, Kimihito Minami, Kenjiro Ishigami, KOSUKE DOI, Takashi Yoshizawa, Yuya Ide, Akiko Fujino, Mitsuru Ishii, Moritake Iguchi, Nobutoyo Masunaga, Masahiro Esato, Hiromichi Wada, Koji Hasegawa, Mitsuru Abe, Masaharu Akao
Journal: Circulation (2023)

Background: The cardiothoracic ratio (CTR) is a readily available and non-invasive tool with which to assess cardiac volume status. We previously reported that N-terminal pro-B-type natriuretic peptide (NT-proBNP) level was associated with higher incidence of clinical events in patients with atrial fibrillation (AF) without pre-existing heart failure (HF). However, it remains unknown whether CTR on chest radiography is associated with the incidence of HF events in AF patients without HF. Methods: The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Kyoto, Japan. After excluding patients with pre-existing HF (defined as having one of the following; prior HF hospitalization, New York Heart Association class ≥2, or left ventricular ejection fraction &lt;40%), we divided 1,049 patients into four groups according to their CTR and NT-proBNP level (median value: 495 ng/L) at baseline, and compared the incidence of HF events (composite of cardiac death or HF hospitalization) among the groups; G1 (Lower CTR&lt;50% and Lower NT-proBNP&lt;495, n=256), G2 (Higher CTR≥50% and Lower NT-proBNP&lt;495, n=268), G3 (Lower CTR&lt;50% and Higher NT-proBNP≥495, n=117) and G4 (Higher CTR≥50% and Higher NT-proBNP≥495, n=408). Results: During the median follow-up of 5.4 years, the incidence rates of HF events in the groups either having higher NT-pro BNP group or higher CTR group were higher, as compared with patients with lower CTR and lower NT-proBNP (G1: 0.5% per person-year, G2: 1.3%, G3: 1.6% and G4: 2.5%; p&lt;0.01) (Figure). Multivariate Cox regression analysis revealed that higher CTR (≥50%) was independently associated with the incidence of HF events in AF patients without prior HF hospitalization (hazard ratio: 1.47, 95% confidence interval: 1.09-2.00). Conclusion: In Japanese AF patients without pre-existing HF, higher CTR was associated with higher incidence of HF events irrespective of NT-proBNP level.
Abstract 16924: Lateral T Wave Inversion in Adolescent Individuals: The Beat-It Cardiac Screening Program
Authors: Mark Abela, Felice Tiziana, Mark Sammut, Christian Scerri, Victor Grech
Journal: Circulation (2023)

Introduction: Cardiac screening is mandated by most sporting organisations. A resting 12-lead ECG may identify individuals who harbour cardiac disorders who may be at risk of sudden cardiac death (SCD). Lateral wave inversion (TWI) may identify subjects with cardiac phenotypes that are linked to SCD. Aim: The aim of this study was to ascertain the prevalence of lateral TWI in adolescent individuals as part of a systematic nationwide cardiac screening. The yield of family screening in these probands was also evaluated. Methodology: A national cardiac screening program (BEAT-IT) was set up in the 2017/2018 scholastic year for students attending year 11 classes. 2672 students (14-17 years) and their legal guardians gave consent. Screening protocol consisted of a questionnaire/ECG at school. ECGs were reported as per the ‘International Recommendations for ECG interpretation’ (2017). Those with contiguous TWI in ≥2 lateral leads were evaluated. An athlete was defined as an individual who participated in organized sport and/or engaged in &gt;4 hours of physical activity weekly. Results: 2672 adolescents gave consent (mean age 15 years, 50.4% female, 95.8% Caucasian, 39.0% athletes). 6 (0.22%) had lateral TWI, extending into the inferior (n=4, 0.15%) or anterior (n=2 (0.07%) leads. The prevalence was the same in both genders (p=0.477) and athletic status (p=0.580). 2 (0.07%) had symptoms, 4 (0.15%) were female, all were Caucasian, 3 (0.11%) were athletes. 4 (0.15%) had borderline or other pathological ECG changes (n=2 LAE, n=1 RAE, n=1 ST depression). 4 (0.15%) had deep TWI (≥2mm). One patient was diagnosed with HCM (0.04%). All subjects are under surveillance. Family screening in relatives (n=27) identified two (7.4%) with cardiomyopathy (n=1 HCM, n=1 DCM). Another 5 (18.5%) had an abnormal ECG requiring surveillance. These findings suggest that some of the participants identified at screening may harbour pre-clinical phenotypes. Conclusion: Lateral TWI is an infrequent finding in young individuals and requires surveillance as it may be a manifestation of heart disease. Family screening may help increase the degree of suspicion of pre-clinical disease in peripubertal individuals.
Abstract 12510: Spatial and Temporal Effects on Human Health Following a Serious Natural Disaster
Authors: Yurika Suzuki, atsushi senda
Journal: Circulation (2023)

Introduction: The effects of disasters can be classified into direct effects and indirect effects. Although direct effects of disasters have been extensively reported, the reports on indirect effects are scarce. We analysed the long-term spatiotemporal effects of The Great East Japan Earthquake, which occurred on March 11, 2011, to elucidate its direct and indirect effects. Methods: The spatial analyses and the temporal analyses were performed using the data from Japanese Diagnosis Procedure Combination (DPC) database from August 01, 2010 to March 31, 2015. Results: The number of patients in DPC-participating hospitals showed apparent decrease with odds ratio of 0.46 (25th-75th percentile 0.10-0.80) immediately after the earthquake (Figure1), and the crude death ratio increased significantly with odds ratio of 1.78 (25th-75th percentile 1.13-2.26), lasting for 12 months (Figure2). This change was not only seen in the disaster area but in the broader area of Japan. The proportion of patients admitted to hospitals due to malignant disease largely decreased (53.8% before earthquake, 34.8% within 1 year after earthquake, odds ratio 0.65), and the proportion of patients admitted to hospitals due to cardiovascular disease largely increased (13.1% before earthquake, 28.5% after earthquake, odds ratio 2.17) within 1 year after the earthquake. Conclusions: A wide-scale natural disaster affects the number of patients and mortality prominently in the disaster area for at least 1 year, especially in patients with cardiovascular disease. The results of this study provide important information for development of future disaster control measures.